Gifts of Love to Dunebrook
(To print this form, only, click on the text and then use your normal print options)

Please print and use this form for contributions, memorial gifts, or for honoring you friends and family on special occasions. A beautiful Lisa & Jet card will be sent to them in your name.

Once completed, mail this form and gift to:

Dunebrook
7451 West Johnson Road
Michigan City, IN 46360

Please accept my tax deductible contribution of $___________
___ Check Enclosed (Please make payable to Dunebrook. )
___ VISA or ___ MasterCard
|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__| exp. ___/___
All contributions are tax-deductible as allowed by law.
Your Name: ___________________________________________________________
Address: _____________________________________________________________
City: ____________________________ State __________ Zip __________
E-mail Address: _____________________________________ (To be held in privacy)
My gift is made:
In Memory of: _________________________________________________________
In Honor of: _________________________ for the occasion of ________
__________________________________________________________

Please Notify :

Name _____________________________________________
Address ___________________________________________
City_____________________________State____________Zip__________
...We thank you for your generosity...